T Nation

23 Low T - UK Help Interpreting Results


#1

Hi Guys

I have been suffering from the usual low T symptoms for almost 18 months now:
• Fatigue – hard to get out of bed in the mornings and struggle to get through the day without copious amounts of coffee.
• Low Libido
• Weak erections
• Mood changes – less sociable and moody
• Struggle to concentrate on things for long
• Bad memory
• Struggling to lose weight after weight gain
• Training quality isn’t as good as it used to be 2 years ago
o I have had to cut down from 6 days a week to a lower intensity 4 days a week. My main goal is strength.
• Lack of motivation – working in Finance I am required to sit regular exams and am struggling for motivation to revise and due to bad memory things are moving slower than they should.
Personal Info
Age: 23 (October 1993)
Height: 5 foot 9 inches
Weight: 110kg (2 years ago I weighted approx. 90kg)
Body Hair: Struggle to grow a beard or any kind of facial or body hair
Diet: Normal day of eating:

  1. 250g Homemade yoghurt with honey
  2. 5 hardboiled eggs
  3. 200g Beef mince, 100g Rice, 100g Broccoli, 5000iu Vit D and 4g Fish Oil
  4. 200g Beef mince, 100g Rice
  5. 50 Cyclic Dextrin, 20g Peptopro during training
  6. Chicken/Beef, Rice/Pasta, veggies
    Please note I used to eat a lot more and not gain weight e.g. 200g of rice per serving on low carb days.

After struggling with NHS doctors since November 2016, they did some blood tests but refused to do a full assessment. T came back right on the low end of the lab ranges, to which I was told I was fine… Finally I have been referred to a private endo in the UK (thankfully I am covered by insurance), he appears to be quite open regarding TRT for younger men as long as there is documented history of symptoms and blood results.

I have attached the recent blood tests he has performed to this post – I also had some more bloods taken yesterday, he will be testing Prolactin as well this time; he feels this may have a bearing on my low t.
Thyroid function I am told looks to be good – there is a history of hypothyroidism in the family as well as type 1 diabetes, so that is good news. If prolactin comes back normal I have been told to come back in 1 month for more bloody tests – assuming no change he will start me on a t gel treatment. The chat around t gel vs injections is one to be had later on when I have more consistent lab results, but some reputable evidence why injections are better is always helpful.
I have had:
An MRI of my head - nothing to report
An ultra sound of my testicles - again nothing to report
I am scheduled to have an ultrasound of my liver, just to make sure my slightly elevate liver enzymes are training related and nothing serious.

I was hoping you guys could have a look through them and give me your feedback on what I should be asking for/telling the endo at our next meeting.
When I asked about SubQ injections I was told that T had to be done intramuscularly, so if any of you have any links or copies of successful SubQ studies that would be greatly appreciated.

Let me know if you need any more info, thanks in advance!


#2

We here stories about the NHS denying treatment to those well below their reference ranges, I believe they really don’t want to bare the costs involved for you over your lifetime. You’re going to need a protocol that will address your low SHBG, you will require at a minimum EOD injections since you’ll basically be dumping your free testosterone. Larger doses of testosterone drives SHBG downwards, this is why more frequent small injections are important.

I was told the same thing regarding SubQ, but it works for some and is especially effective with guys who have low SHBG. If you want the full benefits of testosterone it is recommended going to the gym a couple time a week, TRT alone won’t fix your lifestyle choices. I’ll wait for KSman to respond to you blood work as he’s our resident genius when it comes to labs.

https://naturalbiohealth.com/2015/05/06/shbg-critical-to-your-health/


#3

While your fT4 is strong above mid-range, I suspect that fT3 is below mid-range and/or elevated rT3 is blocking some of the active hormone fT3. TSH should be closer to 1.0 and your TSH suggests lower fT3 receptor activation.

Your iodine intake may be OK, but often is not in UK as many shops do not carry iodized salt.

Check oral body temps as discussed later on to better understand your thyroid function status.

Elevated AST/ALT can be from sore muscles from training. Be fully recovered next time. CRP points to inflammation some where and inflammation is harmful.

Any unexpected rashes?

With low energy, training with adrenalin is harmful to the adrenals. Cortisol should be tested as AM Cortisol at 8AM or 1 hour after waking. Your cortisol does not seem low.

While low SHBG can sometimes point to diabetes, your labs are great in that regard.

Your HTC is very strong for your T levels. With TRT you will need to watch that HTC and RBC do not get high. Note that your pasta and rice may be iron fortified, read labels.

Please read the stickies found here: About the T Replacement Category

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.

KSman is simply a regular member on this site. Nothing more other than highly active.

I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges.

The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.


#4

Hi @KSman
Thanks for coming back to me.

I will ask for fT3 to be tested at my next bloods .

Regarding Iodine - I do not use iodised salt, as you said it is hard to find in stores. However i do eat a lot of eggs so rightly or wrongly assumed I would be getting enough from them?

Morning temps - does it have to be oral? I have a digital ear thermometer, which has given me a consistently normal morning temp.

Elevated AST/ALT - I expected high results due to training less than 24 hours before as I wasn’t expecting bloods to be taken that day, I will bear this in mind for my next appointment.

Unexpected Rashes - No but I do have moderate eczema (bad at the moment) and asthma, could this be the reason for a higher than preferable CRP reading?

My coach is aware of my current issues and has told me to never psych myself up for a lift for that very reason - reducing adrenalin. Although I expect it is inevitable that I will be relying on it somewhat. In fact part of his training ethos is not to psych up for training lifts and to save that for competition day.

Good news about diabetes

HTC and RBC levels - is that simply a case of donating blood if levels get too high? If so that just a good excuse to give blood regularly.

Thanks


#5

HI Guys

I have just had the results from last Saturdays bloods (attached)

Comments from the endo have me a little confused, he has written to my GP surgery with the following letter. I am also at a lose as to why he is not listing my other symptoms but not the end of the world.

He seems to think that my issues may be being caused by a viral infection, but surely not for the full 18 months I have had these symptoms.
Additionally he has mentioned that my T levels have return to ‘normal’ at a level of 8.8 - surely as a 23 year old I should be near the upper end of the range. I do notice that FSH and LH are much higher than last time.

Hoping you guys can come back to me some advice on what I should say to the endo during our next meeting/phone call.

Thanks


#6

I’m sorry the doctors over in the UK are just brain dead, 253 ng/dL for a 23 year old is just insanely low. I don’t understand how any doctor could think those T levels are normal when there are so many diseases associated with T levels below 440 ng/dL. Your doctor contradicted himself in his notes, if safe to say you need a new doctor.


#7

Hi @systemlord

Initial meetings with him seemed so positive that this letter is really disappointing.

I presume I am being dim but I cant see the contradiction - would you mind elaborating. out of interest do you know of any articles or evidence for what hormone levels for young men should be?

I am starting to get very frustrated that I have been feeling really rough for so long and no doctors seem to want to help - I guess we have to persevere and hope a good doctor can be found.

Thanks


#8

The problem I have is he says you’re slightly low testosterone and if you remain there for a long period of time he would consider treatment. Then he states he’s glad to see your testosterone levels returning to normal, the problem here is these reference ranges were either created out of ignorance and the doctors are just following protocol and/or for the purpose of denying treatment to save insurance companies and the NHS from the financial costs involved. The only way forward seems to go private since private doctors are able to think for themselves and stay ahead of the curve on treatment protocols.

When my testosterone was 119 ng/dL , my estrogen was extremely low in the single digits and red blood cell was also low. Inflammation of the bodies tissues is also common symptom of low T, there’s your viral infection. You’re dealing with doctors who find it difficult to have critical thinking of their own and probably need permission to use the restroom. I’m just dumbfounded how it is that these doctors are able to get out of bed every morning and dress themselves.


#9

@systemlord

Thanks for explaining.

I think I need to chat to him re: even though the latest result is in the labs reference range it is still considered very low for a guy my age. Plus reiterate that this has been going on for a while so question the viral explanation.

Do you think the levels quoted in the links below are acceptable ranges for the different age groups? Trying to find evidence of what is expected/statistically normal for healthy men.


I don’t think much will happen for the next month, while we wait for the next set of bloods to be taken - maybe my levels will drop and then he will be forced to reconsider. Otherwise as you stated I think it is time to simply pay privately - annoying as I have kept my health insurance going assuming it would help get a better service.

Thankfully the liver ultrasound has come back normal - been told by the technician that there is some fat on it but nothing out of the ordinary. I should probably try to lose some weight, but with everything else going on it is a struggle.

Thanks


#10

I think any doctor that doesn’t agree that these ranges don’t account for age is just an moron. If you have the testosterone levels of an 80 year old you’re running on an empty gas tank and will sooner or later require treatment. Younger people require more testosterone.

Your doctor’s notes say “low testosterone”, I think that’s pretty definitive. Your doctor is a robot, he can’t think for himself and this is why he is denying you for treatment.